What is the first line treatment for corneal abrasion?

From the Guidelines

The first line treatment for a corneal abrasion should include topical antibiotic prophylaxis using a broad-spectrum antibiotic, such as moxifloxacin 0.5% or ciprofloxacin 0.3%, applied 4 times daily for 3-5 days to prevent infection, especially in patients who wear contact lenses or have suffered trauma. This approach is supported by recent guidelines, including the bacterial keratitis preferred practice pattern 1. The use of topical antibiotics is crucial in preventing acute bacterial keratitis, particularly in high-risk patients.

When managing corneal abrasions, it is essential to consider the risk factors for infection, such as contact lens wear and trauma. In these cases, topical antibiotics should be prescribed to prevent acute infection, as recommended by the bacterial keratitis preferred practice pattern 1. Additionally, patching the eye is not advised, as it may increase the risk of secondary bacterial keratitis 1.

Pain management is also an important aspect of treating corneal abrasions. Oral analgesics, such as NSAIDs or acetaminophen, can be used to manage pain. A cycloplegic agent, like cyclopentolate 1% or homatropine 5%, may be used to reduce pain from ciliary spasm. Topical NSAIDs, like ketorolac 0.5%, may provide additional pain relief but should be used short-term, as they can delay epithelial healing with prolonged use.

In terms of specific treatment regimens, erythromycin ointment or fluoroquinolone drops, such as moxifloxacin 0.5% or ciprofloxacin 0.3%, applied 4 times daily for 3-5 days, can be effective in preventing infection. Patients should avoid contact lens wear until complete healing occurs and should be advised to return if symptoms worsen. Most corneal abrasions heal within 24-72 hours with appropriate treatment, thanks to the corneal epithelium's remarkable regenerative capacity 1.

From the Research

First Line Treatment for Corneal Abrasion

• The first line treatment for corneal abrasion is symptomatic, consisting of foreign body removal and analgesia with topical nonsteroidal anti-inflammatory drugs or oral analgesics 2, 3
• Topical antibiotics may also be used to prevent infection, although evidence is lacking to support their use 2, 3
• Eye patching is not recommended as it does not improve pain and may delay healing 2, 3
• The goals of treatment include pain control, prevention of infection, and healing 3

Use of Topical Antibiotics

• There is insufficient evidence to support the use of topical antibiotics in the treatment of corneal abrasion 4
• A review of two randomized controlled trials found that the use of topical antibiotics did not significantly reduce the risk of infection or improve healing time 4
• However, topical antibiotics may still be prescribed to prevent bacterial superinfection, particularly in high-risk populations 3, 4

Pain Management

• Pain relief may be achieved with topical nonsteroidal anti-inflammatory drugs or oral analgesics 2, 3
• The degree of pain was not affected by the use of topical antibiotics in one study 4

Follow-up and Referral

• Follow-up may not be necessary for patients with small, uncomplicated abrasions, normal vision, and resolving symptoms 3
• Referral is indicated for any patient with symptoms that do not improve or worsen, a corneal infiltrate or ulcer, significant vision loss, or a penetrating eye injury 3